Along with the stress of combatting the disease itself, leukemia and lymphoma bring with them a mountain of medical bills and out-of-pocket expenses. Co-pays, deductibles, prescriptions, even travel to your doctor and hospital can leave you wondering where you are going to find the money to pay the next bill.

If you live within 100 miles of Chicago or in the state of Illinois, the Leukemia Research Foundation may be able to help. We provide financial assistance to qualified patients and families. Our program reimburses almost any treatment-related expense not covered by your medical insurance.

HOW TO APPLY:

To be eligible for financial assistance from the LRF, you must live within 100 miles of Chicago or in the state of Illinois. You must also provide the following information:

  1. A completed application form. To receive an application, call the LRF office at (847) 424-0600 or download it below.
  2. A written diagnosis from your physician. We cannot process your application without a medical diagnosis. Please do not send in your application without your physician's statement.
  3. Tax returns from the past two years (IRS forms only; supporting schedules not required)

 

Send these items to:
Leukemia Research Foundation
Attn: Financial Assistance
3520 Lake Ave, Ste 202
Wilmette, IL 60091-1064


We will notify you by mail of your application's status, within one month of its receipt. If you are accepted into the program, we will mail you specific guidelines and procedures for reimbursement.

APPLICATIONS FOR DOWNLOAD:
The application form here is an Adobe PDF file, recognizable by both PC and Macintosh computers. You will require the free Adobe Reader software, available by clicking HERE if you do not already have it installed.

To download and print the application form, click HERE. For a fill-in form, click HERE.

TRANSPORTATION REIMBURSEMENT FORM DOWNLOAD:
This form is for patients who have received a letter stating they have been approved to the Financial Assistance Program and wish to submit for transportation expense reimbursement.  To download, please click HERE.